Table 3.

Interventions

Target System	Types of Exercise	Goals	Examples	Progression	HEP Examples	Terminate/Red Flags
Cardiovascular	Aerobic	To progressively increase cardiovascular endurance and activity tolerance with minimal to no symptom exacerbation	Initial 10 minute warmup on bicycle ergometer, additional biking, walk/jog, elliptical	When patient is able to complete aerobic exercise without symptom exacerbation, anaerobic and sports‐specific activities are introduced	10 minutes walking with intensity set by treating therapist usually at Borg level 11‐13	Excessive symptom exacerbation or aberrant vitals
	Anaerobic, Sport‐Specific	To progressively increase sport‐specific endurance and activity tolerance with minimal to no symptom exacerbation	Swimming, agility ladder, mountain climbers, tuck jumps, ball skills	Incorporation of work/rest ratios to reflect sport‐specific demands	Non‐contact, sport‐specific participation with activity modification based on symptom exacerbation	Excessive symptom exacerbation or aberrant vitals
Musculoskeletal	Stretching	To normalize ROM, flexibility, posture and pain management	Stretching of levatorscapuale and upper trapezius	Manual stretching by therapist to self‐stretch by patient	Levator scapulae and upper trapezius stretch for 30 seconds each multiple times throughout the day	Positive findings for cervical instability and/or vertebral artery syndrome
	Resistance Exercise	To increase heart rate through large muscle group activation and condition for eventual sport‐specific purposes	Sidestepping w/ theraband, walking lunges, leg press, push ups	Alter work/rest ratio to reflect interval workout as patient demonstrates proper control of the activity	Sidestepping with theraband, participation in resistance training regimen at local gym	Excessive symptom exacerbation or aberrant vitals
	Postural Re‐Education	To improve activation and control of appropriate postural musculature	Deep neck flexor endurance, scapular retractions, planks, rows, prone walkouts on a stability ball	Movement from gravity‐ minimized to against gravity positioning, use of stable surface with progression to stability ball and/or TRX	Prone chin tuck with various scapular/shoulder movements	Positive findings for cervical instability and/or vertebral artery syndrome
	Manual Therapy	To improve joint mobility, cervical ROM, and pain management	Soft tissue mobilization, suboccipital release, manualglides at C2, first rib mobilizations	Incorporate more or less duration and techniques as per patient response	Manual therapy was not prescribed as part of the HEP	Positive findings for cervical instability and/or vertebral artery syndrome
Postural Control	Balance	To address deficits in balance, stability, proprioception, postural and lower extremity neuromuscular control	Single leg, double leg and tandem stance activities, plyotoss with a weighted ball on the rockerboard, BOSU squats, Biodex	Progress from double leg to single leg and tandem stance activities, firm to unstable surface, add perturbations	Single leg balance	Excessive instability indicating heightened fall risk
	Dual Tasking	To address concomitant cognitive deficits that accompany musculoskeletal symptoms of concussion	Single leg balance on an unstable surface while reciting the alphabet backwards, scheduling of appointments during busy times in the clinic	add cognitive element or layers to task after patient demonstrates adequate ability in the controlled environment	Dual tasking was not prescribed as part of the HEP	Excessive instability indicating heightened fall risk
Vestibular/ Oculomotor	Gaze Stability	To eliminate symptom exacerbation with concurrent head/eye movement	Repetitive horizontal head turns with the eyes fixed on a target in front of you	Increase speed, repetitions, and change background/ complexity	Horizontal head turns up to 30 repetitions without symptom exacerbation before discontinuation of the exercise	Excessive vestibular symptoms that necessitate a referral to a vestibular specialist

ROM = range of motion; TRX = suspension training system; P/A = posterior/anterior; HEP = home exercise program